ATI LPN
ATI PN Comprehensive Predictor 2020
1. A nurse is assisting with the admission of a client who has major depressive disorder. Which of the following communication techniques should the nurse use to establish a trusting relationship with the client?
- A. Offer medical advice
- B. Offer general leads
- C. Ask open-ended questions
- D. Use assertive communication
Correct answer: B
Rationale: In the context of establishing a trusting relationship with a client who has major depressive disorder, offering general leads is the most appropriate communication technique. General leads encourage clients to express themselves by providing subtle prompts or cues, which can help build rapport and trust. Offering medical advice (Choice A) is not suitable as it may come across as imposing and could hinder the establishment of trust. Asking open-ended questions (Choice C) is beneficial for eliciting detailed responses but may not be as effective at initially establishing trust as general leads. Using assertive communication (Choice D) can be perceived as aggressive and intimidating, which is not conducive to building a trusting relationship with a client who has major depressive disorder.
2. What is the most effective way to prevent the spread of infection in a healthcare setting?
- A. Hand hygiene
- B. Wearing personal protective equipment
- C. Sterilizing equipment
- D. Isolating infected patients
Correct answer: A
Rationale: Hand hygiene is considered the most effective method to prevent the spread of infection in a healthcare setting. Proper hand hygiene, including washing hands with soap and water or using hand sanitizer, is crucial in reducing the transmission of pathogens from one person to another. While wearing personal protective equipment, sterilizing equipment, and isolating infected patients are also important infection control measures, they are not as universally effective as hand hygiene in preventing the spread of infections. Personal protective equipment can prevent contact with infectious materials, sterilizing equipment reduces the risk of contamination, and isolating infected patients helps prevent the spread of specific infections, but they are more targeted approaches compared to the broad and essential practice of hand hygiene.
3. A nurse is teaching a client how to administer enoxaparin. Which of the following instructions should the nurse include?
- A. Inject the medication into the muscle of the thigh
- B. Massage the injection site after administration
- C. Pinch the skin before injecting
- D. Administer the medication at the same time each day
Correct answer: C
Rationale: The correct instruction for administering enoxaparin is to pinch the skin before injecting. Pinching the skin helps create a proper fold for subcutaneous injections like enoxaparin, ensuring proper delivery of the medication into the subcutaneous tissue. Choice A is incorrect because enoxaparin should be administered subcutaneously, not into the muscle. Injecting it into the muscle can lead to complications. Choice B is incorrect because massaging the injection site after administration can increase the risk of bleeding or bruising due to the anticoagulant properties of enoxaparin. Choice D is incorrect as it is a general instruction and does not specifically relate to the administration of enoxaparin.
4. Which nursing action is a priority when caring for a client with heart failure?
- A. Encourage the client to drink fluids frequently
- B. Weigh the client daily to monitor fluid balance
- C. Increase fluid intake to prevent dehydration
- D. Limit the client's sodium intake
Correct answer: B
Rationale: Weighing the client daily is a priority action when caring for a client with heart failure because it helps monitor fluid balance. This monitoring is essential in managing heart failure as it allows healthcare providers to assess for signs of fluid retention or depletion, which are crucial in adjusting treatment plans. Encouraging the client to drink fluids frequently (Choice A) may worsen fluid overload in heart failure patients. Increasing fluid intake (Choice C) can exacerbate fluid retention. While limiting sodium intake (Choice D) is important in heart failure management, monitoring fluid balance through daily weighing takes precedence as a priority nursing action.
5. A nurse is caring for a client with an NG tube who is experiencing nausea and decreased gastric secretions. What is the priority nursing action?
- A. Increase the suction pressure
- B. Turn the client onto their side
- C. Irrigate the NG tube with sterile water
- D. Replace the NG tube with a new one
Correct answer: D
Rationale: The correct answer is to replace the NG tube with a new one. When a client with an NG tube experiences nausea and decreased gastric secretions, it indicates a possible problem with the tube itself. Replacing the tube ensures proper functioning and can alleviate the symptoms. Increasing the suction pressure (Choice A) can worsen the client's condition. Turning the client onto their side (Choice B) may be helpful in some situations but does not address the underlying issue. Irrigating the NG tube with sterile water (Choice C) is not the priority and may not resolve the problem.
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